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Pain in the ear
Ringing in the one ear
Hearing loss worse on the right
Have a runny nose
Stomach was uncomfortable, then had a fever
Have a fever
Have facial pain
Not seeing your symptoms? No worries!
Infection of the middle ear (area just behind the eardrum) by bacteria or viruses. Contributing factors include nasal obstruction by adenoids and allergic rhinitis. The symptoms can include ear pain or fullness, fevers, and muffled hearing. This is more common in children but can also present in adults. In severe cases, the eardrum may rupture leading to drainage coming out the ear canal.
Your doctor may ask these questions to check for this disease:
As the majority of otitis media is caused by viruses/colds, this condition is often self-limited and can be treated with over-the-counter analgesics. Importantly, antibiotics are not effective against viruses and the fluid that comes before or after the infection will not be affected by antibiotics. Nasal steroids or antihistamines may be helpful to treat the underlying eustachian tube dysfunction. If the infection is recurrent or lasts for a long time a tiny tube may be inserted into the eardrum to help fluid drain and allow for the treatment with ear drops instead of oral antibiotics.
Reviewed By:
Eric A. Gantwerker, MD, MMSC (Otolaryngology (ENT))
Pediatric Otolaryngologist at Northwell Health and Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell. He holds a Master of Medical Science (MMSc) in Medical Education with a special focus on educational technology, educational research, and game-based learning from Harvard Medical School and a Master of Science in Physiology and Biophysics from Georgetown University. He has a special interest in faculty development and has been a speaker or faculty at hundreds of local, national, and international courses and conferences. He is also an active blogger and podcaster for several organizations, including the Harvard Macy Institute (HMI), Harvard Medical School CME Online, and BackTable Innovations. He has been featured in the news and print for media outlets such as USA Today, Businesswire, The Washington Post, Nature Medicine, Fox News, and KevinMD. He was also the Vice President, Medical Director of a medical video game company, Level Ex from 2018 to 2023 that utilized game technology and psychology to create interactive experiences for healthcare professionals. | He is recognized as an expert on the implementation of educational technologies and gaming with a foundation in educational theory for health professions education. He was honored to be inducted as an Associate Member of the American College of Surgeons (ACS) Academy of Master Surgeon Educators and as an Associate Fellow of the Association for Medical Education in Europe (AMEE).
Rohini R, MD (Otolaryngology (ENT))
Dr. Rohini R is an ENT, Head and Neck Surgeon, with a Fellowship in Advanced Endoscopic Sinus and Skull Base Surgery and a Fellowship in Aesthetic Medicine and Lasers. Besides clinical practice and working with Ubie, she is actively training and mentoring medical students and residents. She has functioned in various work settings - teaching hospitals, private and free health centers, and worked with patients from all socioeconomic backgrounds due to her experience in free hospitals and volunteering in India and Singapore.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Q.
Ears Won’t Pop? Why Eustachian Tube Dysfunction Happens & Medical Next Steps
A.
Ears that will not pop are most often due to eustachian tube dysfunction, a usually temporary issue from colds, allergies, sinus inflammation, or rapid pressure changes that causes fullness and muffled hearing; there are several factors to consider, and simple steps like swallowing, yawning, gentle Valsalva, saline, and allergy care often help. Seek care if symptoms last more than two weeks, are one sided and do not improve, or you have severe pain, fever, ear drainage, sudden hearing loss, or persistent dizziness; for medical next steps and options like nasal steroids, ear tubes, or balloon dilation, see the complete guidance below.
References:
* Tarabichi M, et al. Eustachian Tube Dysfunction: A Review. OTO Open. 2020 Apr 1;4(2):2473974X20919357. doi: 10.1177/2473974X20919357. PMID: 32395567.
* Anand V, et al. Eustachian tube dysfunction. Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):3460-3467. doi: 10.1007/s12070-021-02682-1. Epub 2021 Aug 17. PMID: 36698651.
* Gliklich RE, et al. Balloon Dilation of the Eustachian Tube: A Systematic Review. Otolaryngol Head Neck Surg. 2022 Sep;167(3):374-382. doi: 10.1177/01945998211059424. Epub 2022 Jan 24. PMID: 35073177.
* Mistry ST, et al. Eustachian tube function and dysfunction: A review. Curr Opin Otolaryngol Head Neck Surg. 2023 Oct 1;31(5):329-335. doi: 10.1097/MOO.0000000000000921. PMID: 37722744.
* Schilder AG, et al. Eustachian tube dysfunction: aetiology, diagnosis and treatment of a complex problem. BJA Educ. 2019 Nov;19(11):353-359. doi: 10.1016/j.bjae.2019.08.006. Epub 2019 Sep 28. PMID: 31630761.
Q.
Is it Mastoiditis? Why your ear bone is swelling and medically approved next steps.
A.
Swelling behind the ear can be mastoiditis, a serious complication of a middle ear infection, especially if there is red, tender swelling with fever, the ear sticking out, drainage, worsening pain, or hearing changes. Medically approved next steps are to seek urgent care for severe or worsening symptoms, have an ear exam and possibly a CT, and start treatment such as IV antibiotics, drainage, or surgery if needed; there are several factors to consider, so see the complete guidance below.
References:
* Choi, J. Y., & Lee, W. S. (2021). Mastoiditis: Current Concepts in Diagnosis and Management. *Current Otorhinolaryngology Reports*, *9*(1), 1–9.
* Psarommatis, I. M., et al. (2018). Acute mastoiditis: a systematic review. *Acta Otorhinolaryngologica Italica*, *38*(3), 185–194.
* Zanoletti, E., & Bussi, M. (2022). Acute Mastoiditis: Clinical Features, Imaging, and Management. *Ear, Nose & Throat Journal*, *101*(6), NP246-NP251.
* Lammers, T., & Klussmann, J. P. (2020). Guidelines for diagnosis and treatment of acute mastoiditis. *HNO*, *68*(1), 64–70.
* Groves, M., et al. (2020). Acute Mastoiditis: A Multicenter Analysis of Incidence, Management, and Outcome. *The Pediatric Infectious Disease Journal*, *39*(2), 123–128.
Q.
Severe Ear Pain? Why Your Middle Ear Is Inflamed: Otitis Media & Medical Next Steps
A.
Severe ear pain is often caused by otitis media, an infection or inflammation of the middle ear that can follow colds or allergies and lead to pressure, muffled hearing, fever, and sometimes drainage; while many mild cases improve with pain relievers and watchful waiting, severe, persistent, or worsening symptoms need medical evaluation and sometimes antibiotics, and red flags like high fever, swelling behind the ear, stiff neck, confusion, vomiting, or facial weakness require urgent care. There are several factors to consider. See below for complete guidance on types of otitis media, home care, when a ruptured eardrum or lingering fluid needs ENT follow up, risk reduction, and prevention to help decide your next steps.
References:
* PMID: 35711679
* PMID: 28943719
* PMID: 23434689
* PMID: 32679261
* PMID: 33023062
Q.
Constant Pain? Why Your Middle Ear is Infected + Medically Approved Next Steps
A.
Constant ear pain, pressure, and muffled hearing often come from a middle ear infection that follows a cold or allergy when the Eustachian tube blocks and fluid gets trapped behind the eardrum; most cases improve with the right care. Medically approved steps include relieving pain with acetaminophen or ibuprofen, watchful waiting for 48 to 72 hours if symptoms are mild, starting antibiotics if symptoms are severe or persist, and seeking urgent care for red flags like high fever, severe headache, swelling behind the ear, dizziness, or worsening drainage. There are several factors to consider that could change your next steps, so see below for complete details.
References:
* Rosenfeld RM, Schwartz SR, Piltcher OB. Pain in Otitis Media. Otol Neurotol. 2017 Aug;38 Suppl 3:S143-S154. doi: 10.1097/MAO.0000000000001550. PMID: 28541999.
* Bhattacharyya N. Pathophysiology and Pain Management of Otitis Media. Clin Rev Allergy Immunol. 2018 Jun;54(3):400-409. doi: 10.1007/s12016-018-8686-3. PMID: 29546522.
* Sieswerda A, Bragança S, Ghaffar F, van Belkum A, Rots NY, van der Horst S, Sanders EAM. Otitis media: aetiology, treatment and prevention. Nat Rev Dis Primers. 2017 Mar 2;3:17004. doi: 10.1038/nrdp.2017.4. PMID: 28256565.
* Pelton SI, Johnson CE. Diagnosis and Management of Acute Otitis Media. Am Fam Physician. 2019 May 15;99(10):621-628. PMID: 31083907.
* van den Aardweg MT, Schilder AG. Chronic otitis media: aetiology, diagnosis, and management. BMJ. 2021 Mar 17;372:m1073. doi: 10.1136/bmj.m1073. PMID: 33731427.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP. Otitis media: diagnosis and treatment. Am Fam Physician. 2013 Oct 1;88(7):435-40. Erratum in: Am Fam Physician. 2014 Mar 1;89(5):318. Dosage error in article text. PMID: 24134083.
https://www.aafp.org/pubs/afp/issues/2013/1001/p435.htmlShirai N, Preciado D. Otitis media: what is new? Curr Opin Otolaryngol Head Neck Surg. 2019 Dec;27(6):495-498. doi: 10.1097/MOO.0000000000000591. PMID: 31592792.
https://journals.lww.com/co-otolaryngology/Abstract/2019/12000/Otitis_media__what_is_new_.12.aspxVenekamp RP, Damoiseaux RA, Schilder AG. Acute Otitis Media in Children. Am Fam Physician. 2017 Jan 15;95(2):109-110. PMID: 28084706.
https://www.aafp.org/pubs/afp/issues/2017/0115/p109.htmlWallis S, Atkinson H, Coatesworth AP. Chronic otitis media. Postgrad Med. 2015 May;127(4):391-5. doi: 10.1080/00325481.2015.1027133. PMID: 25913599.
https://www.tandfonline.com/doi/full/10.1080/00325481.2015.1027133